Selection in reproductivemedicine today relies on normative assessments of what ‘good life’ consists of. This paper explores the terms under which such assessments are made by focusing on three particular concepts of ‘quality’: quality of life, biological quality and population quality. It is suggested that the apparently conflicting hypes, hopes and fears that surround reproductivemedicine can co-circulate because of the different forms of normative assessment that these concepts allow. To ensure clarity in bioethical deliberations (...) about selection, it is necessary to highlight how these differing forms of assessment are mobilized and invoked in practices of and debates about reproductivemedicine. (shrink)
Whilst India has been debating how to regulate 'surrogacy' the UK has undergone a major consultation on increasing the amount of 'expenses'paid to egg 'donors', while France has recently finished debating its entire package of bioethics regulation and the role of its Biomedicine Agency. Although it is often claimed that there is no alternative to the neo-liberal, market-based approach in regulating (or not) reproductivemedicine--the ideology prevalent in both India and the UK--advocates of that position ignore the alternative (...) model offered by France's tighter regulation, as well as its overarching concern with protecting the vulnerable and ensuring social justice. Whilst the concepts underpinning the French model of regulation also have their provenance in Western political philosophy and not in the developed world, they embody a very different attitude and suggest that there is indeed an alternative to letting the market decide. However, even in France that alternative is highly contested. (shrink)
In its recent statement 'Sex Selection and Preimplantation Genetic Diagnosis', the Ethics Committee of the American Society of ReproductiveMedicine concluded that preimplantation genetic diagnosis for sex selection for non-medical reasons should be discouraged because it poses a risk of unwarranted gender bias, social harm, and results in the diversion of medical resources from genuine medical need. We critically examine the arguments presented against sex selection using preimplantation genetic diagnosis. We argue that sex selection should be available, at (...) least within privately funded health care. (shrink)
This paper addresses the topic of bioethics in reproductivemedicine from the perspective of the religious implications for the field. The assumption underlying the approach is that religion remains a factor that influences the field of bioethics even in a secularized postmodern society. The first part of the paper analyses the main bioethical issues which mark obstetrics and gynecology, uttering that the four basic principles of bioethics are available both in obstetrics and gynecology and must be applied in (...) association with the practitioner’s virtues. The second part of the paper focuses on the main directions that guide the debate on the presence of religion in the field of bioethics, with a special interest in their relevance for reproductivemedicine. Despite the difficulties implied by the task of advocating for the place of religion at the secular table of deliberation in medical ethics, the relevance of religion for bioethics cannot be ignored. (shrink)
Questions concerning the parent/ patient’s autonomy are seen as one of the most important reasons for requesting Ethics Consultations. Respecting parent/ patient’s autonomy also means respecting the patient’s wishes. But those wishes may be controversial and sometimes even go beyond legal requirements. The objective of this case series of 32 ECs was to illustrate ethically challenging parent / patients’ wishes during the first stages of life and how the principle of patient’s autonomy was handled. The case series has a qualitative (...) retrospective approach. A documentary sheet was designed de novo and information was gained from EC minutes and medical charts. The cases originate from the following specialties: reproductivemedicine, obstetrics and neonatology as well as two interdisciplinary cases. Through the structured EC minutes aspects of patient / parents’ wishes could be identified explicitly. Overall the patient / parents’ wishes were not supported in 61% of the cases. Central reasons for rejection of patient / parent wishes were mainly the protection of the best interest of the unborn / new-born child as well as the rejection of clinical approaches that were regarded as being substandard treatment. The study shows that treatment decisions in reproductivemedicine, obstetrics and neonatology raise substantial ethical questions leading to the request for ethics consultation. The systematic case series presented here gives insight into the ethical reflection carried out to support the clinicians in their decision-making and counselling. It shows that clinicians, after using ethics consultation, make deliberate decisions that do not “automatically” fulfil the treatment requests of the patients and parents. (shrink)
In Medical Sexism: Contraception Access, ReproductiveMedicine, and Health Care, Jill B. Delston uses a feminist lens to examine the overwhelmingly common gynecological practice of declining to write prescriptions for oral contraceptives unless a woman agrees to an annual Pap smear, which is used to detect precancerous changes, as well as cancer of the cervix. Employing a comprehensive evaluation of the medical literature, Delston methodically builds a strong argument that these measures not only do not follow evidence-based medical (...) guidelines, but they also carry a significant potential of harm to the patient. Furthermore, cervical cancer prevention has absolutely nothing to do with... (shrink)
This essay sets down three directives for conscientiously objecting clinicians—physicians, particularly obstetrician/gynecologists, trained in NaProTechnology by the Pope Paul VI Institute and Creighton University School of Medicine and any medical professionals who share their natural law vision of reproductive health care—to protect their right to well-formed conscientious objection in reproductivemedicine. Directive one: understand the nature of a well-formed conscience and its rightful exercise. Directive two: fulfill all reasonable American College of Obstetricians and Gynecologists’ requirements for (...) conscientious refusal. Directive three: execute a political strategy to protect health-care conscience rights. (shrink)
Why do some doctors routinely deny birth control refills without additional tests, and why do some doctors disrespect patient autonomy in decisions about abortions, labor and delivery, organ transplants, and more? This book argues that medical sexism is a major cause of this pervasive mistreatment.
Social, political, and economic environments play an active role in nurturing professional virtue. Yet, these environments can also lead to the erosion of virtue. As such, professional virtue is fragile and vulnerable to environmental shifts. While physicians are often considered to be among the most virtuous of professional groups, concern has also always existed about the impact of commercial arrangements on physicians’ willingness and capacity to enact their professional virtues. This article examines the ways in which commercial arrangements have been (...) negotiated to secure medical virtue from real or perceived threats of erosion. In particular, we focus on the concern surrounding conflicts of interest arising from commercial arrangements that have developed as a result of neoliberal economic and social policies. The deregulation of medical markets and privatization of services have produced new commercial relationships that are often misunderstood by patients, publics, and physicians themselves. ‘Conflicts of interest’ policies have been introduced in an attempt to safeguard ethical conduct and medical practice. However, a number of virtue ethicists have critiqued these policies as inadequate for securing virtue. We examine the ways in which commercial arrangements have been seen to impact upon medical virtue, both historically and in the context of modern medicine. We then describe and critique current efforts to restore clinical virtue through both conflict of interest policies and through virtue ethics. Finally, we suggest some possible ways of addressing the corrosive effects of neoliberalism on medical virtue. (shrink)
It is a common feature of debates on the regulation of reproductivemedicine to find law portrayed as a crude form of intervention consisting in the imposition of inflexible rules on doctors and medical researchers. This paper argues that this view must be replaced by a more accurate assessment of the law's potential role in the regulation of reproductivemedicine. From an analysis of the White Paper on human fertilisation and embryology, and in particular the proposed (...) Statutory Licensing Authority, the author contends that far from being an inflexible method of regulation law can foster discussion and compromise. (shrink)
Assisted reproduction , particularly that performed using donated gametes, increases the prospect of healthy babies being delivered to increasing numbers of people striving for parenthood. The psychosocial, ethical and legislative issues related both to the donation and receipt of gametes are perceived as extraordinarily complicated. In 2009, a research project aimed at mapping the issues was drawn up and implemented in the Czech Republic. The project should have provided material for consultation purposes, for the work of ethical and legislative bodies, (...) and for better interdisciplinary and international communication in reproductivemedicine. Work on the project was affected by several unforeseen events, particularly by the drafting and adoption of a new law on ART . The article describes the dynamic and structural changes occurring within the project due to drafting of the bill as well as the changes and consequences resulting from other circumstances related to the topic researched. (shrink)
The paper discusses the practice of genetic counseling and elective abortion in the German Democratic Republic. Keywords: elective abortion, embryo transfer, in vitro fertilization, protection of human life, reproductive ethics, German Democratic Republic, bioethics CiteULike Connotea Del.icio.us What's this?
The diffusion of medical technology is largely determined by the marketplace demands supported by national and historical contexts. Using the cases of cesarean delivery and newborn intensive care in the United States, this article presents the argument that the interaction of four factors accounts for the rapid diffusion of untested technologies. These factors are economic expansion in an unrestricted market, the vulnerability of the patient population, a social disposition towards emergency medicine, and the vested interest of medical specialists.
Background Against a background of on the one hand, a declining demography and a conservative family register system that emphasizes the importance of the blood line, and on the other hand, an increase in the number of people undergoing fertility treatment, the absence of a legal regulatory framework concerning ART matters is likely to result in an increasing number of contradictory situations. It is against this background that the paper sets out to examine the judgements of court cases related to (...) ART, with a particular focus on the legal determination of parental status, and to link these to aspects of the legal and socio-ethical environment within which the courts make their judgements. Methods The methods used were thorough investigation of all the court cases concerning ART in the public domain in Japan, including the arguments of the concerned parties and the judgements so far delivered. With the court cases as a central focal point, trends in Japan, including deliberations by government and academic societies, are reviewed, and the findings of surveys on the degree of understanding and attitudes among the people toward ART are summarized. Results In terms of the judgements to date, the central criteria used by the courts in determining parental status were the act of parturition and the consent of the husband of the concerned couple. The government and academic societies have displayed a cautious attitude toward ART, but the findings of attitude surveys among the people at large show a generally positive attitude toward ART. Attitudes toward the overwhelming importance hitherto attached to the bloodline are also seen to be changing. Conclusion The main conclusion is that in the absence of a legal regulatory framework for ART, there is likely to be an increase in the contradictions between the use of outdated legal precedents and the technical development of ART. Since much of the specialist discussion necessary for the formulation of a legal framework has already been carried out, the speedy enactment of comprehensive and at the same time flexible legislation would be highly desirable, but further wide-ranging discussion involving the general public is likely to be needed first. (shrink)
The social interface between reproductivemedicine and embryonic stem cell research has been investigated in a pilot study at a large IVF clinic in central China. Methods included observation, interviews with hospital personnel, and five in-depth qualitative interviews with women who underwent IVF and who were asked for their consent to the donation of embryos for use in medical (in fact human embryonic stem cell) research. This paper reports, and discusses from an ethical perspective, the results of an (...) analysis of these interviews. The participants talked of extreme social pressure to become pregnant. Once they had a baby, ‘spare’ embryos lost practical significance due to the Chinese one-child policy. In the context of decision making about donating embryos to research, the women used the clinical distinctions between ‘good and bad quality’ embryos and also between frozen and transferred embryos, as guiding moral distinctions. In the absence of concrete information about what sort of research their embryos should be used for, the women interviewed either refused consent (for fear that the embryo would be given to another couple) or accepted, expressing motives of solidarity with other women in a similar situation. This reveals that they filled the knowledge gap with an image of research improving fertility treatment. (shrink)
The concept of reproductive health promises to play a crucial role in improving health care provision and legal protection for women around the world. This is an authoritative and much-needed introduction to and defence of the concept of reproductive health, which though internationally endorsed, is still contested. The authors are leading authorities on reproductivemedicine, women's health, human rights, medical law, and bioethics. They integrate their disciplines to provide an accessible but comprehensive picture. They analyse 15 (...) cases from different countries and cultures, and explore options for resolution. The aim is to equip readers to fashion solutions in their own health care circumstances, compatibly with ethical, legal and human rights principles. (shrink)
ZusammenfassungDer Begriff Leiden ist in der Medizin und in der Bioethik bisher kaum reflektiert und dahingehend in normativer Hinsicht wenig bestimmt. Dennoch bildet das Leiden an einer Unfruchtbarkeit den Ausgangspunkt für die medizintechnischen Interventionen der assistierten reproduktionsmedizinischen Behandlung. Dabei wird implizit angenommen, dass der unerfüllte Kinderwunsch ein Leiden ist. Ob der unerfüllte Kinderwunsch allerdings ein Leiden darstellt, ist bisher nicht eindeutig geklärt worden.Ziel dieses Beitrages ist es, die Annahme, dass es sich beim unerfüllten Kinderwunsch um ein Leiden handelt, zu überprüfen. (...) Anhand der Darstellung einiger gängiger Leidenskonzeptionen werden Merkmale von Leiden herausgearbeitet, die als treffende Grundannahmen für eine Leidensbestimmung gelten können. Es wird sich zeigen, dass der unerfüllte Kinderwunsch, entsprechend der Leidenskonzeptionen, als ein Leiden angesehen werden sollte, und ihm somit ein normativer Stellenwert zukommt. In einem weiteren Schritt ist zu klären, ob das Leiden an einem unerfüllten Kinderwunsch als ein Rechtfertigungsgrund für reproduktionsmedizinische Interventionen gelten kann. Dafür wird zum einen der Stellenwert von Leiden, als eine anthropologische Grundbedingung, im Zusammenhang mit dem Leidenslinderungsauftrag der Medizin diskutiert. Zum anderen werden die Risiken der reproduktionsmedizinischen Therapien sowie deren Bedeutung als Gesundheitsressourcen erörtert. Dabei wird deutlich, dass Leiden an einem unerfüllten Kinderwunsch immer ein psychosomatischer Komplex ist. Nur unter Berücksichtigung der psychoexistenziellen Dimension des Leidens ergibt sich eine Legitimation für eine angemessene somatische Intervention.Definition of the problem In medicine and bioethics, the term “suffering” is not clearly defined from a normative point of view. Nevertheless, suffering due to infertility is the starting point for medical interventions in assisted reproductivemedicine. This implies that the unfulfilled desire to have children is a form of suffering, but the validity of this statement has not yet been clarified. Arguments Based on descriptions of some common concepts, certain characteristics of suffering are identified. We discuss the significance of suffering as an anthropological condition in connection with the mission of medicine to alleviate human suffering. Furthermore, the risks of reproductive treatment and their significance for health are addressed. Conclusion We conclude that the unfulfilled desire to have children is a form of suffering, and therefore has a normative value. The legitimacy of appropriate somatic intervention can only be established by taking the psycho-existential dimension of suffering into account. (shrink)
ZusammenfassungDie Möglichkeiten der Reproduktionsmedizin erweitern sich ständig. Bei einigen Maßnahmen assistierter Reproduktion ist es oft unklar, ob eine Indikation vorliegt oder ob diese Maßnahmen als wunscherfüllend anzusehen sind. Die Unterscheidung zwischen medizinisch indizierter Maßnahme und wunscherfüllender Behandlung hängt von dem hier verwendeten Konzept der Indikation ab. Daher kommt dem Konzept der Indikation auf dem Gebiet der Reproduktionsmedizin ein besonderer Stellenwert zu. Dabei fällt auf, dass die Abgrenzung zwischen medizinisch indizierter Behandlung und Wunschbehandlung nicht allein klinisch begründet ist, sondern implizit oder (...) explizit normative Urteile enthält. Der sprachlich-kommunikative Aspekt spielt hierbei eine zentrale Rolle. Der übliche Sprachgebrauch von „indiziert“ suggeriert ein Urteil, das allein auf empirisch-klinischen Fakten basiert, und verdeckt die normativen Urteile, die in das Konzept der Indikation einfließen. Ziel des vorliegenden Beitrags ist es, den normativen Gehalt der Indikation in der Reproduktionsmedizin zu analysieren. Grundlage ist die eingehende Betrachtung des Konzepts der Indikation und der besonderen Stellung der Indikation in der Reproduktionsmedizin. Aus dieser Betrachtung ergibt sich, dass der normative Gehalt der Indikation von einem soziokulturellen Skript bezüglich Elternschaft geprägt ist, das sich v. a. im Leistungsrecht niederschlägt. Dieses Skript enthält gesellschaftliche Anschauungen, Normen und Rollenbilder und kann als „gute Elternschaft“ bezeichnet werden. Das Skript der guten Elternschaft wirkt als Regulativ, das durch leistungsrechtliche Vorgaben über den Zugang zu reproduktionsmedizinischen Maßnahmen bestimmt. Es basiert auf traditionellen heteronormativen Ehe- und Familienkonzepten und sieht Elternschaft für heterosexuelle, verheiratete Paare vor. Somit ergibt sich der Widerspruch, dass Verfahren der Reproduktionsmedizin, die den Raum für die Fortpflanzung jenseits traditionell-heteronormativer Konzepte öffnen, von ebenjenen Konzepten legitimiert und limitiert werden.Definition of the problem The options of reproductivemedicine are expanding. In some cases, it is unclear whether there is a medical indication for applying procedures of assisted reproduction or whether this application is wish-fulfilling. The distinction between medical indication and wish fulfilment depends on the concept of indication. Thus, the concept of indication has a special status in reproductivemedicine. The distinction between medical indication and wish-fulfilling treatment is mostly based on implicit or explicit normative judgements, rather than on mere clinical facts. The use of “indicated” suggests a purely empirical-clinical judgment, whereas the normative judgements behind the concept are concealed. The aim of this paper is to analyze the normative implications of indication in reproductivemedicine. Therefore, the concept of indication and its special status within reproductivemedicine is scrutinized. Arguments The analysis shows that the normative implications of indication are tied to a sociocultural script of parenthood, which manifests in the regulations of reimbursement. This script encompasses societal views, norms, and role models, and can be described as “good parenting”. The script of good parenting acts as a regulatory instance that determines the access to procedures of assisted reproduction. It is based on traditional heteronormative concepts of marriage and family, and reserves reproduction exclusively for heterosexual, married couples. Conclusion The sociocultural script of good parenting in reproductivemedicine implies a contradiction: Assisted reproduction technologies provide the opportunity of reproduction for individuals outside the heteronormative frame, yet they are legitimized and limited by this exact frame. (shrink)
A reductive reading of Humanae vitae seeks to limit its appeal to a ban on contraception. In truth, however, it offers a vision of human sexuality and conjugal love with broad and enduring relevance. In setting forth the intrinsic complementarity and irreducibility of the unitive and procreative dimensions of the conjugal act, Paul VI has given us a hermeneutical key for assessing many contemporary ethical dilemmas in human reproductivemedicine. From this perspective, this article seeks to apply the (...) logic of Humanae vitae to several real-life scenarios confronted by medical practitioners, educators, and ethicists working in the field of fertility and reproductive health. These include a consideration of the ethics of prescribing hormonal contraceptives, the possibilities of investigating male infertility, issues of cooperation in counseling and assisting conception in same-sex relationships, the ethics pertaining to assisted reproductive technology, the contested case of prenatal adoption, and the application of double-effect reasoning. On the occasion of the fiftieth anniversary of the promulgation of Pope Paul VI's encyclical Humanae vitae, this article seeks to defend its enduring relevance to modern-day society, through application of its reasoning to contemporary dilemmas in reproductivemedicine. It considers real cases of the ethics of prescribing hormonal contraceptives, of investigating male infertility, of cooperating in counseling and assisting conception in same-sex relationships, of ART, of prenatal adoption, and the application of double-effect reasoning. (shrink)
Enhancement of autonomous choice may be considered as an important reason for facilitating the use of genetic tests such as preimplantation genetic diagnosis. The principle of respect for autonomy is a crucial component not only of Western liberal traditions but also of Western bioethics. This is especially so in bioethical discussions and analyses of clinical encounters within medicine. On the basis of an analysis of qualitative research interviews performed with British, Italian and Swedish geneticists and gynaecologists on ethical aspects (...) of preimplantation genetic diagnosis, the plausibility of the notion of autonomy within reproductivemedicine is discussed. The analysis of interviews indicates not only that there is a gap between theoretical discussions and concrete practice, but also that an increase in choice — paradoxically — can hamper couples' choice. (shrink)
This book is an attempt to provide a new “ethical framework” that can then be applied to issues in reproductive and perinatal medicine. A new framework is needed because moral theories such as utilitarianism and Kantian ethics have proved to be deficient in deciding specific cases. The author seeks to balance two fundamental values: reproductive freedom and respect for life.
It has recently been argued that reproductive genetic manipulation technologies like mitochondrial replacement and germline CRISPR modifications cannot be said to save anyone’s life because, counterfactually, no one would suffer more or die sooner absent the intervention. The present article argues that, on the contrary, reproductive genetic manipulations may be life-saving (and, from this, have therapeutic value) under an appropriate population health perspective. As such, popular reports of reproductive genetic manipulations potentially saving lives or preventing disease are (...) not necessarily mistaken, though such terminology still requires further empirical validation. (shrink)
The identification and valorization of unacknowledged, feminized forms of economic productivity has been an important task for feminist theory. In this article, we expand and rethink existing definitions of labour, in order to recognize the essential economic role women play in the stem cell and regenerative medicine industries, new fields of biomedical research that are rapidly expanding throughout the world. Women constitute the primary tissue donors in the new stem cell industries, which require high volumes of human embryos, oöcytes, (...) foetal tissue and umbilical cord blood. Such material is generally given for free in the advanced industrial democracies, constituted as a surplus or waste whose generative powers should not be withheld from others. At the same time, among impoverished female populations in developing nations, such biological material is now often procured through frankly transactional relations, where women undertake risky procedures for small fees. In each case, female bodily productivity is mobilized to support bioeconomic research, yet the economic value involved in these relations is largely unacknowledged. In this article, we consider both the gift economy and the transactional economy for reproductive tissues as a form of labour. In order to fully conceptualize the specificities of feminized productivity in the bioeconomy, we distinguish between earlier feminist theories of reproductive labour and the emerging practices generated by stem cell research, which we term regenerative labour. We consider how historical transformations in the regulation of feminized labour and the technical repertoires of stem cell research renegotiate the productivity limits of female reproductive biology, opening it out to novel and profitable forms of surplus value and enrolling women in complex negotiations over their role in bioeconomic activity. (shrink)
Giulia Cavaliere disagrees with claims that ectogenesis will increase equality and freedom for women, arguing that they often ignore social context and consequently fail to recognise that ectogenesis may not benefit women or it may only benefit a small subset of already privileged women. In this commentary, I will contextualise her argument within the broader cultural milieu to highlight the pattern of reproductive advancements and technologies, such as egg freezing and birth control, being presented as the panacea for women’s (...) inequality. While these advancements and technologies can benefit women, I argue medicine is not the best tool to ‘cure’ social problems and should not be co-opted as an agent of social change. Systemic social changes, not just technomedical approaches, are needed to address the root of gender inequality, which is social in nature, not medical. (shrink)
It is often argued that it does not matter morally whether biomedical interventions treat or prevent diseases or enhance nondisease traits; what matters is whether and how much they promote well-being. Therapy and enhancement both promote well-being, the argument goes, so they are not morally distinct but instead continuous. I provide three reasons why this argument should be rejected when it is applied to choices concerning the genetic makeup of future people. First, it rests on too simple a conception of (...) the badness of disease. Second, it wrongly assumes that disease avoidance and enhancement can proceed with similar accuracy. Third, it overlooks that disease avoidance tends to be more urgent than enhancement from the point of view of distributive justice. Although none of these reasons establishes a firm therapy-enhancement distinction, they show that a continuum model is not an attractive alternative. (shrink)
This paper explores the ethics of introducing genome-editing technologies as a new reproductive option. In particular, it focuses on whether genome editing can be considered a morally valuable alternative to preimplantation genetic diagnosis. Two arguments against the use of genome editing in reproduction are analysed, namely safety concerns and germline modification. These arguments are then contrasted with arguments in favour of genome editing, in particular with the argument of the child’s welfare and the argument of parental reproductive autonomy. (...) In addition to these two arguments, genome editing could be considered as a worthy alternative to PGD as it may not be subjected to some of the moral critiques moved against this technology. Even if these arguments offer sound reasons in favour of introducing genome editing as a new reproductive option, I conclude that these benefits should be balanced against other considerations. More specifically, I maintain that concerns regarding the equality of access to assisted reproduction and the allocation of scarce resources should be addressed prior to the adoption of genome editing as a new reproductive option. (shrink)